Yueh Hann Ziong, Tung Kuan Kai, Tung Chun Fang
Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan.
Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Case Rep Gastroenterol. 2021 Feb 12;15(1):163-170. doi: 10.1159/000512410. eCollection 2021 Jan-Apr.
A 47-year-old man complained intermittent dull pain at the right upper quadrant abdomen and right neck swelling for 3 months. Blood tests revealed leukocytosis with mild eosinophilia. Computed tomography (CT) showed the presence of multiple nodules in the liver and both lung fields. Positron emission tomography/CT (PET/CT) scans found increased uptake at lymph nodes of the right neck, in the lung, liver, and prostate. The patient was diagnosed with IgG4-related disease (IgG4-RD) based on the biopsy findings from the right neck lymph nodes, showing enriched IgG4-positive lymphoplasmacytic cells. It is often difficult to distinguish IgG4-RD from malignancy, especially in presentations with multiple pseudotumors. This case serves as a reminder that IgG4-RD should be considered in earlier diagnosis, since pseudotumors in multiple organs may imitate tumor metastases.
一名47岁男性主诉右上腹间歇性隐痛及右颈部肿胀3个月。血液检查显示白细胞增多伴轻度嗜酸性粒细胞增多。计算机断层扫描（CT）显示肝脏和双肺野有多个结节。正电子发射断层扫描/计算机断层扫描（PET/CT）发现右颈部淋巴结、肺、肝脏和前列腺摄取增加。根据右颈部淋巴结活检结果，该患者被诊断为IgG4相关性疾病（IgG4-RD），显示IgG4阳性淋巴浆细胞丰富。IgG4-RD常难以与恶性肿瘤区分，尤其是在出现多个假瘤的情况下。该病例提醒我们，在早期诊断时应考虑IgG4-RD，因为多个器官的假瘤可能模仿肿瘤转移。
